US4776338A - Cardiac pacer for pacing a human heart and pacing method - Google Patents
Cardiac pacer for pacing a human heart and pacing method Download PDFInfo
- Publication number
- US4776338A US4776338A US06/874,596 US87459686A US4776338A US 4776338 A US4776338 A US 4776338A US 87459686 A US87459686 A US 87459686A US 4776338 A US4776338 A US 4776338A
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- Prior art keywords
- rate
- pacing
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
- A61N1/36521—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure the parameter being derived from measurement of an electrical impedance
Definitions
- the invention relates to a cardiac pacer for pacing a heart, in particular a human heart, wherein the pacing rate is controlled by a signal that is dependent upon physical activity or a measured physiological change in the body of a patient.
- the conventional cardiac pacers can suffer from erroneous rate increases either due to instability or drift in the sensor itself or due to sensing of interference or due to a poor coupling between the sensed variable and the corresponding physiological need for cardiac output.
- rate-responsive pacemaker systems are implanted have low tolerance for the strain of a prolonged elevated heart rate, these conditions represent a potential hazard to the patient.
- an improved cardiac pacer which comprises
- (e) means for forcing the pacing rate back to a lower rate if the pacing rate runs at or above a predetermined high rate for a predetermined time period.
- FIG. 1 shows a first embodiment of a cardiac pacer comprising the invention in a schematic block diagram.
- FIG. 2 shows a second embodiment of a cardiac pacer comprising the invention in a schematic block diagram:
- FIG. 3 shows the time base unit of the embodiment of FIGS. 1 and 2 in more detail.
- FIG. 4 shows another embodiment of a cardiac pacer comprising the invention in a schematic block diagram having an impedence measuring electrode.
- FIGS. 1 and 2 a human heart which has to be paced is generally designated with 1.
- a pacing electrode 2 is inserted in the human heart 1 in a manner and position such that the heart can most efficiently be paced.
- the pacing electrode 2 is connected through a pacing lead 3 with a pacing pulse generator 4.
- a timing circuit 5 controls the pacing rate of the pacing pulse generator 4 through line 6.
- an impedance pneumograph (also called a pneumatograph) 7 comprises an AC source 8 generating a continuous alternating current, a demodulator 9, a filter 10, a non-linear amplification circuitry 11, an integrator 12, and a voltage to pulse rate converter 13.
- the AC source 8 is connected with the pacing lead 3 through leads 14, 15.
- the demodulator 9 is connected with the pacing lead 3 through leads 15, 16. Under the circumstances the current of the AC source 8 is supplied to the pacing electrode 2 together with the pacing pulses 17.
- This embodiment can be modified as shown in FIG. 4 wherein a separate electrode is provided for impedance measurement. In this case the AC source 8 and the demodulator 9 are disconnected from pacing lead 3 and instead are connected through additional lead 18 with the separate impedance measuring electrode 19. In both cases the output signal of the demodulator 9 is a measure for the breathing rate, i.e. a respiratory signal.
- the pacing pulse generator 4, the timing circuit 5 and the impedance pneumograph 7 are all encapsuled in an implantable conductive (metallic) housing 20 which is the housing of the cardiac pacer.
- the conductive housing 20 defines both the indifferent electrode for pacing and the second electrode for impedance measurement as indicated in FIG. 1 with reference numeral 21.
- the pacing pulse generator 4 comprises an output capacitor 26 which is switchable by means of switch 27 between battery 28 (switch position A) and pacing lead 3 (switch position B).
- switch position A the output capacitor 26 is charged by the battery 28 to a voltage V1.
- switch position B the output capacitor 26 is discharged through pacing lead 3 as pacing pulse 17.
- the amount of discharge depends on the impedance variations of the patient's thorax during respiration.
- the pacing pulse 17 discharges from V1 to V2 (amplitude decay D).
- the sample and hold circuitry 23 samples and holds the voltages V1, V2 of output capacitor 26.
- the difference former 24 forms the difference V1-V2 which is again a measure for the breathing rate, i.e. a respiratory signal.
- the non-linear amplification circuitry 11 amplifies the filtered respiratory signal such that signal portions having higher amplitudes are more amplified than signal portions having lower amplitudes. Under the circumstances signal portions of interest including the respiration signal, are enhanced with respect to low amplitude noise for further processing.
- Non-linear amplification circuits of this kind are well known in the art and need not be described in more detail.
- the output signal of the non-linear amplification circuitry 11 is integrated in integrator 12 over a period of time, e.g. in the range of 5 to 30 s. By integrating high-frequency noise is significantly reduced.
- the voltage to pulse rate converter 13 in FIGS. 1 and 2 converts the integrated signal into a pulse rate according to the breathing rate.
- the voltage to pulse rate converter 13 controls the timing circuit 5 through line 29 such that a predetermined (e.g. programmable) basic pacing rate of the pacing pulse generator 4 is varied dependent on the respiratory signal.
- the line 30 is a control line from the time base unit 5 to the sample and hold circuitry 23 of impedance pneumograph 22.
- the timing circuit 5 comprises a zero decoder 31, a decremented counter 32 having a reset input 33, a time base register 34, a logic gate 35, an analog signal to digital control word converter 36, a high rate comparator 37 for the output of the time base register 34 and a predetermined high rate value, e.g. 120 beats/min. of a high rate value generator 38, an integrator 39, a threshold discriminator 40, a time/threshold selector 41 connected with the threshold discriminator 40, a monostable multivibrator 42 and a time/pulse width selector 43 connected with the monostable multivibrator 42.
- the analog signal to digital control word converter 36 converts the analog pulse rate signal of the voltage to pulse rate converter 13 into a digital control word.
- This digital control words is supplied through open gate 35 to the time base register 34. It controls the time base register 34 such that a basic pacing rate, e.g. 60 beats/min., is varied dependent on the respiration rate.
- a basic pacing rate e.g. 60 beats/min.
- the time base register 34 increases the counting speed of the decremental counter 32 so that it reaches zero faster than at basic rate.
- the zero decoder 31 generates switching signals at higher rates, so that the output capacitor 26 of the pacing pulse generator 4 charges and discharges at higher rates. As a result the pacing rate increases dependent on increasing breathing rate as desired.
- the high rate comparator 37 generates an output signal, e.g. a DC signal, which is integrated by integrator 39.
- the output signal of integrator 39 exceeds the preselected threshold of the threshold discriminator 40.
- the threshold discriminator 40 in response triggers a monostable multivibrator 42 which generates an output pulse the width of which is programmable by means of time/pulse width selector 43. This output pulse of monostable multivibrator 42 continues until the end of the output pulse.
- time base register 34 is disconnected from the output of the analog signal to digital control word converter 36.
- the time base register 34 switches back to basic pacing rate, e.g. 60 beats/min.
- this invention safeguards a patient, in particular elderly patient, against the strain of a prolonged elevated heart rate. If the pacer runs for a predetermined time at or above a predetermined high rate, then it will react as if the control signal which is dependent upon physical activity (here the respiration signal) disappeared so that the pacer automatically returns to its basic pacing rate. The time during which the pacer will run at basic rate after a forced return to basic rate is programmable. An additional criterion which may be used is that the control signal sensor input must return below the predetermined high rate to a lower value before the pacer starts tracking the control signal again.
- the heart rate may be elevated for may hours during normal physical activity.
- the rate limitation is only activated when the pacer stays at the high rate for the prolonged period of time.
- Another variation of the invention allows for the forced return at a predetermined rate between the basic rate and the high rate of the pacemaker.
- the impedance measurement electrodes do not need to be implanted. They can also be secured on the patient's chest, if desired. Such a possibility is for example illustrated in U.S. Pat. No. 3,593,718.
- any other signal of physiologic need for increased cardiac output e.g. temperature, pO 2 signal etc., may be employed to control the rate of the pacer.
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- Health & Medical Sciences (AREA)
- Cardiology (AREA)
- Heart & Thoracic Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Biophysics (AREA)
- Physiology (AREA)
- Engineering & Computer Science (AREA)
- Hematology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Radiology & Medical Imaging (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Electrotherapy Devices (AREA)
Abstract
Description
Claims (17)
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US06/874,596 US4776338A (en) | 1986-06-16 | 1986-06-16 | Cardiac pacer for pacing a human heart and pacing method |
EP87108112A EP0249821B2 (en) | 1986-06-16 | 1987-06-04 | A cardiac pacer for pacing a heart |
DE8787108112T DE3778586D1 (en) | 1986-06-16 | 1987-06-04 | HEART PACEMAKERS FOR STIMULATING A HEART. |
JP62147805A JPH0647024B2 (en) | 1986-06-16 | 1987-06-12 | Heart pacemaker |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US06/874,596 US4776338A (en) | 1986-06-16 | 1986-06-16 | Cardiac pacer for pacing a human heart and pacing method |
Publications (1)
Publication Number | Publication Date |
---|---|
US4776338A true US4776338A (en) | 1988-10-11 |
Family
ID=25364137
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US06/874,596 Expired - Lifetime US4776338A (en) | 1986-06-16 | 1986-06-16 | Cardiac pacer for pacing a human heart and pacing method |
Country Status (4)
Country | Link |
---|---|
US (1) | US4776338A (en) |
EP (1) | EP0249821B2 (en) |
JP (1) | JPH0647024B2 (en) |
DE (1) | DE3778586D1 (en) |
Cited By (85)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4907593A (en) * | 1987-05-21 | 1990-03-13 | Biocontrol Technology, Inc. | Adaptation of heart pacing to physical activity |
US5016632A (en) * | 1989-08-28 | 1991-05-21 | Siemens Aktiengesellschaft | Medical device and method for stimulating a physiological event in a patient with a stimulation intensity automatically adapting to the physical activity of the patient |
US5016630A (en) * | 1988-02-01 | 1991-05-21 | Siemens Aktiengesellschaft | Heart pacemaker with hysteresis function |
US5036849A (en) * | 1990-04-04 | 1991-08-06 | Cardiac Pacemakers, Inc. | Variable rate cardiac pacer |
US5137019A (en) * | 1990-03-08 | 1992-08-11 | Cardiac Pacemakers, Inc. | Variation in cardiac chamber volume or pressure as a controlling parameter |
DE4126363A1 (en) * | 1991-08-06 | 1993-02-11 | Biotronik Mess & Therapieg | Cardiac pacemaker with efficiency detection - has differentiating element producing output signal as measure of cardiac activity |
US5284136A (en) * | 1990-04-04 | 1994-02-08 | Cardiac Pacemakers, Inc. | Dual indifferent electrode pacemaker |
US5344430A (en) * | 1991-11-20 | 1994-09-06 | Medtronic, Inc. | Method and apparatus for termination of ventricular tachycardia and ventricular fibrillation |
US5549646A (en) * | 1994-12-06 | 1996-08-27 | Pacesetter, Inc. | Periodic electrical lead intergrity testing system and method for implantable cardiac stimulating devices |
US5571158A (en) * | 1991-08-06 | 1996-11-05 | Biotronik Mess- Und Therapiegeraete Gmbh & Co. Ingenieurbuero Berlin | Stimulation Electrode |
WO1996036395A1 (en) * | 1995-05-19 | 1996-11-21 | Medtronic, Inc. | Respiratory muscle electromyographic rate responsive pacemaker |
US5800470A (en) * | 1994-01-07 | 1998-09-01 | Medtronic, Inc. | Respiratory muscle electromyographic rate responsive pacemaker |
US20040260348A1 (en) * | 2003-06-19 | 2004-12-23 | Bakken Earl E. | Method and apparatus for temporarily varying a parameter in an implantable medical device |
US20110098761A1 (en) * | 2009-10-23 | 2011-04-28 | Medtronic Cryocath Lp | Method and system for preventing nerve injury during a medical procedure |
US9853743B2 (en) | 2015-08-20 | 2017-12-26 | Cardiac Pacemakers, Inc. | Systems and methods for communication between medical devices |
US10029107B1 (en) | 2017-01-26 | 2018-07-24 | Cardiac Pacemakers, Inc. | Leadless device with overmolded components |
US10046167B2 (en) | 2015-02-09 | 2018-08-14 | Cardiac Pacemakers, Inc. | Implantable medical device with radiopaque ID tag |
US10064564B2 (en) | 2013-08-23 | 2018-09-04 | Medtronic Cryocath Lp | Method of CMAP monitoring |
US10065041B2 (en) | 2015-10-08 | 2018-09-04 | Cardiac Pacemakers, Inc. | Devices and methods for adjusting pacing rates in an implantable medical device |
US10137305B2 (en) | 2015-08-28 | 2018-11-27 | Cardiac Pacemakers, Inc. | Systems and methods for behaviorally responsive signal detection and therapy delivery |
US10159842B2 (en) | 2015-08-28 | 2018-12-25 | Cardiac Pacemakers, Inc. | System and method for detecting tamponade |
US10183170B2 (en) | 2015-12-17 | 2019-01-22 | Cardiac Pacemakers, Inc. | Conducted communication in a medical device system |
US10220213B2 (en) | 2015-02-06 | 2019-03-05 | Cardiac Pacemakers, Inc. | Systems and methods for safe delivery of electrical stimulation therapy |
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US10328272B2 (en) | 2016-05-10 | 2019-06-25 | Cardiac Pacemakers, Inc. | Retrievability for implantable medical devices |
US10350423B2 (en) | 2016-02-04 | 2019-07-16 | Cardiac Pacemakers, Inc. | Delivery system with force sensor for leadless cardiac device |
US10357159B2 (en) | 2015-08-20 | 2019-07-23 | Cardiac Pacemakers, Inc | Systems and methods for communication between medical devices |
US10391319B2 (en) | 2016-08-19 | 2019-08-27 | Cardiac Pacemakers, Inc. | Trans septal implantable medical device |
US10413733B2 (en) | 2016-10-27 | 2019-09-17 | Cardiac Pacemakers, Inc. | Implantable medical device with gyroscope |
US10426962B2 (en) | 2016-07-07 | 2019-10-01 | Cardiac Pacemakers, Inc. | Leadless pacemaker using pressure measurements for pacing capture verification |
US10434317B2 (en) | 2016-10-31 | 2019-10-08 | Cardiac Pacemakers, Inc. | Systems and methods for activity level pacing |
US10434314B2 (en) | 2016-10-27 | 2019-10-08 | Cardiac Pacemakers, Inc. | Use of a separate device in managing the pace pulse energy of a cardiac pacemaker |
US10463305B2 (en) | 2016-10-27 | 2019-11-05 | Cardiac Pacemakers, Inc. | Multi-device cardiac resynchronization therapy with timing enhancements |
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Families Citing this family (8)
Publication number | Priority date | Publication date | Assignee | Title |
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US4730618A (en) | 1986-06-16 | 1988-03-15 | Siemens Aktiengesellschaft | Cardiac pacer for pacing a human heart and pacing method |
US4790318A (en) | 1986-06-16 | 1988-12-13 | Siemens Aktiengesellschaft | Cardiac pacer for pacing a human heart |
GB2214813A (en) * | 1988-01-14 | 1989-09-13 | Stuart Charles Webb | Rate-responsive pacemaker |
US4901725A (en) * | 1988-01-29 | 1990-02-20 | Telectronics N.V. | Minute volume rate-responsive pacemaker |
US5063927A (en) * | 1988-02-17 | 1991-11-12 | Webb Stuart C | Rate-responsive pacemaker |
GB8803613D0 (en) * | 1988-02-17 | 1988-03-16 | Lewis L M | Rate-responsive pacemaker |
SE9002129D0 (en) * | 1990-06-15 | 1990-06-15 | Siemens Elema Ab | DEVICE FOR STIMULATION OF LIVING WEAVEN |
US6016446A (en) * | 1998-02-27 | 2000-01-18 | Cardiac Pacemakers, Inc. | Cardiac rhythm management system including nonlinear, non-blanking sense amplifier |
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1987
- 1987-06-04 EP EP87108112A patent/EP0249821B2/en not_active Expired - Lifetime
- 1987-06-04 DE DE8787108112T patent/DE3778586D1/en not_active Expired - Lifetime
- 1987-06-12 JP JP62147805A patent/JPH0647024B2/en not_active Expired - Lifetime
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US5036849A (en) * | 1990-04-04 | 1991-08-06 | Cardiac Pacemakers, Inc. | Variable rate cardiac pacer |
US5284136A (en) * | 1990-04-04 | 1994-02-08 | Cardiac Pacemakers, Inc. | Dual indifferent electrode pacemaker |
US5571158A (en) * | 1991-08-06 | 1996-11-05 | Biotronik Mess- Und Therapiegeraete Gmbh & Co. Ingenieurbuero Berlin | Stimulation Electrode |
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US5344430A (en) * | 1991-11-20 | 1994-09-06 | Medtronic, Inc. | Method and apparatus for termination of ventricular tachycardia and ventricular fibrillation |
US5800470A (en) * | 1994-01-07 | 1998-09-01 | Medtronic, Inc. | Respiratory muscle electromyographic rate responsive pacemaker |
US5549646A (en) * | 1994-12-06 | 1996-08-27 | Pacesetter, Inc. | Periodic electrical lead intergrity testing system and method for implantable cardiac stimulating devices |
WO1996036395A1 (en) * | 1995-05-19 | 1996-11-21 | Medtronic, Inc. | Respiratory muscle electromyographic rate responsive pacemaker |
US20040260348A1 (en) * | 2003-06-19 | 2004-12-23 | Bakken Earl E. | Method and apparatus for temporarily varying a parameter in an implantable medical device |
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Also Published As
Publication number | Publication date |
---|---|
EP0249821B1 (en) | 1992-04-29 |
JPS6311174A (en) | 1988-01-18 |
DE3778586D1 (en) | 1992-06-04 |
EP0249821B2 (en) | 2000-05-03 |
JPH0647024B2 (en) | 1994-06-22 |
EP0249821A1 (en) | 1987-12-23 |
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